When a woman requests emergency contraception:

• Reassure her that the consultation will remain confidential, and that there are safe and effective methods to prevent pregnancy after unprotected sex. It is important to reassure all people, particularly young people, that their consultation will remain confidential. However, information may needed to be shared with other health and social professionals if existing or potential abuse is disclosed (e.g. for child protection).
• Assess her:
• Current risk of pregnancy.
• Need for future contraception.
• Risk for sexually transmitted infection.
• Risk for non-consensual sexual intercourse/abuse.
• Vulnerability.
• Provide information (verbal and clarification):
• On the options that are available: the levonorgestrel pill, the ulipristal acetate pill, and the copper intrauterine device (IUD).
• Their pros and cons.
• Their mechanisms of action.
• To someone younger than 16 years of age who is requesting emergency contraception without parental consent.
• Counsel (but do not lecture) her on the emotional and physical implications of sexual activity, including the risks of, and consequences of, pregnancy and the risk of sexually transmitted infections.
• Assess her competency to make an independent consent to treatment, and document in her case notes that she meets (or does not meet) the Fraser criteria for competence to independently consent.
• Offer the appropriate method of emergency contraception.
• Levonorgestrel is licensed for use in women over 16 years of age. It can be used up to 72 hours (3 days) after unprotected sexual intercourse, but its effectiveness diminishes with time.
• Levonorgestrel emergency contraception may also be considered between 72 and 120 hours after unprotected sexual intercourse. Ideally it should be taken as soon as possible because its effectiveness diminishes with time.
• Levonorgestrel is easier to obtain than an IUD for emergency contraception.
• Ulipristal acetate is only available on prescription and can be used up to 120 hours (5 days) after unprotected sexual intercourse.
• Ideally, ulipristal acetate should be used as soon as possible but studies have shown that the efficacy of ulipristal acetate is maintained over the 120 hour interval.
• Safety and efficacy has only been established in women over 18 years of age.
• An IUD containing at least 380 mm² of copper is the most effective method.
• An IUD (or advice on how to obtain one) should be offered to all women attending for emergency contraception.
• An IUD can always be fitted anytime in the menstrual cycle up to 5 days after the first episode of unprotected sexual intercourse. If the timing of ovulation can be estimated, insertion can be beyond 5 days of unprotected sexual intercourse, as long as it does not occur beyond 5 days after ovulation.
• Ideally, an emergency IUD should be fitted at first presentation, but insertion can be offered later, at the woman's convenience; levonorgestrel or ulipristal emergency contraception should always be given in the interim.
• If facilities are unavailable for emergency IUD insertion, local referral mechanisms should facilitate timely access to a specialist who can provide this service.
• Address other related needs that have become apparent during the consultation.
• Offer to arrange ongoing regular contraception, if this is appropriate — see the CKS topic on Contraception.
• If the woman does not want ongoing regular contraception, offer advance provision of levonorgestrel to promote early use of emergency contraception.
• For women at higher risk for sexually transmitted infection, offer advice, one to one discussion on preventing sexually transmitted infection, testing (for Chlamydia trachomatis as a minimum if an IUD is to be inserted).
• Refer or manage adolescents or women who have been abused, or who are at risk for sexual abuse.
• Follow-up and aftercare for levonorgestrel, ulipristal acetate, and IUD:
• Vomiting soon after taking levonorgestrel or ulipristal acetate. The woman should return (as soon as possible) for another dose if she vomits within 2 hours of taking levonorgestrel or 3 hours of taking ulipristal acetate.
• Early bleeding. Advise the woman that she may have light bleeding or spotting after taking levonorgestrel or ulipristal acetate; her period may be earlier or later than normal.
• Pregnancy is suspected despite emergency contraception. Advise the woman to have a pregnancy test if her next menstruation is abnormally late (e.g. 5–7 days) or lighter than usual.